Provider Demographics
NPI:1033989595
Name:PICKETT, MARQUITA T
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:T
Last Name:PICKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 DEBUYS RD APT 228
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-3515
Mailing Address - Country:US
Mailing Address - Phone:769-229-1998
Mailing Address - Fax:
Practice Address - Street 1:248 DEBUYS RD APT 228
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-3515
Practice Address - Country:US
Practice Address - Phone:769-229-1998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst